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Archives of Gynecology and Obstetrics

, Volume 291, Issue 4, pp 907–915 | Cite as

Clinical relevance of objectifying colposcopy

  • Giuseppe F. Vercellino
  • Evrim ErdemogluEmail author
  • Vito Chiantera
  • Katharina Vasiljeva
  • Al-Hakeem Malak
  • Achim Schneider
  • Gerd Böhmer
Gynecologic Oncology

Abstract

Purpose

To evaluate the clinical value of four objective colposcopic criteria inner border, ridge sign, cuffed crypt openings and rag sign to diagnose cervical intraepithelial neoplasia grade 2 or worse (CIN 2+), using video exoscopy and to compare it to subjective graduating signs.

Methods

Retrospective evaluation of video recordings of 444 patients, referred for diagnostic colposcopy, who underwent cervical biopsies, and if indicated loop excisions. Most severe histological diagnosis was recorded. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LR) with 95 % confidence interval, for CIN 2+ were calculated.

Results

Single biopsy, two biopsies and magnification-guided loop excision were performed in 60.8, 39.2 and 70.5 % of patients, respectively. Sensitivity, specificity, PPV and NPV to detect CIN 2+ were 19.3, 99.2, 98.3 and 35.8 %, for inner border sign; 53.1, 93.5, 94.7 and 47.6 %, for ridge sign; 51.5, 84.9, 88.2, and 44.3 %, for cuffed crypt openings, and 40.7, 96.4, 96.1 and 42.5 %, for rag sign, respectively. The positive likelihood ratio (LR+) was 26.7 and the negative likelihood ratio (LR−) was 0.81, for inner border sign; 8.2 and 0.5, for ridge sign; 3.41 and 0.57 for cuffed crypt openings; and 11.3 and 0.62 for rag sign, respectively. 90 % of CIN 2+ had at least one objective sign. Combination of any two objective signs significantly increased the LR of the presence of CIN 2+, and was clinically superior to any combination of graduating signs.

Conclusion

Objective colposcopic criteria are clinically useful and significantly associated with CIN 2+.

Keywords

High grade cervical intraepithelial neoplasia Colposcopy Exoscopy Objective signs 

Notes

Acknowledgments

The authors thank Rita Maier for data collection. We dedicate this article to AnnelieseJähn 1932–2012 who dedicated her professional career to the prevention of cervical cancer at Charité University Medicine, Berlin, Germany.

Conflict of interest

Achim Schneider acts as advisor for Karl Storz, GSK and Sanofi Pasteur. He received honoraria for lectures.

Supplementary material

Supplementary material 1 (MOV 17166 kb)

Supplementary material 2 (MOV 55294 kb)

Supplementary material 3 (MOV 55332 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Giuseppe F. Vercellino
    • 1
  • Evrim Erdemoglu
    • 2
    Email author
  • Vito Chiantera
    • 1
  • Katharina Vasiljeva
    • 3
  • Al-Hakeem Malak
    • 1
    • 4
  • Achim Schneider
    • 1
    • 3
  • Gerd Böhmer
    • 5
  1. 1.Department of Gynecology and Gynecologic OncologyCharite UniversityBerlinGermany
  2. 2.Department of Gynecologic Oncology, Faculty of MedicineSuleyman Demirel UniversityIspartaTurkey
  3. 3.Department of Gynecology and Gynecologic OncologyCharité-Campus CharitéMitteBerlinGermany
  4. 4.Gynecology DepartmentKing Saud University Medical CollegeRiyadhSaudi Arabia
  5. 5.Colposcopy Clinic Wagner StibbeBad MünderGermany

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